Heavy Workload Research Articles

WEATHERING THE STORM: A SYSTEMATIC LITERATURE REVIEW OF WEATHER STATIONS’ OBSERVATIONAL PRACTICES

This literature review examines the accuracy, error frequency, and the impact of workload and decision-making on the weather observations made by PAGASA synoptic station personnel in the Cordillera Administrative Region (CAR). The accuracy of weather data collected by PAGASA is critical for reliable forecasting and timely decision-making in various sectors, including agriculture, disaster management, and transportation. The review highlights key factors influencing data accuracy, such as instrument calibration and human error. Studies show that while the accuracy of weather observations is generally high, occasional discrepancies occur, often due to technical issues or human mistakes in data recording, especially during extreme weather events. The review also explores the frequency of errors in weather observation data. Research indicates that errors are infrequent, but they are more likely to occur during severe weather conditions or in cases of equipment malfunctions or power failures. Although external factors can occasionally disrupt the data collection process, the overall frequency of errors remains relatively low. Furthermore, the impact of workload and decision-making on the accuracy of observations is discussed. Heavy workloads during peak weather seasons and the pressure of rapid decision-making during extreme weather events were found to contribute to an increased likelihood of errors. Studies emphasize the importance of managing workload and decision-making stress to maintain the quality of data. The review concludes by suggesting that further research, training, and technological improvements are needed to enhance the accuracy and reliability of weather observations in PAGASA synoptic stations in CAR.

Ontological Airspace-Situation Awareness for Decision System Support

Air Traffic Management (ATM) has become complicated mainly due to the increase and variety of input information from Communication, Navigation, and Surveillance (CNS) systems as well as the proliferation of Unmanned Aerial Vehicles (UAVs) requiring Unmanned Aerial System Traffic Management (UTM). In response to the UTM challenge, a decision support system (DSS) has been developed to help ATM personnel and aircraft pilots cope with their heavy workloads and challenging airspace situations. The DSS provides airspace situational awareness (ASA) driven by knowledge representation and reasoning from an Avionics Analytics Ontology (AAO), which is an Artificial Intelligence (AI) database that augments humans’ mental processes by means of implementing AI cognition. Ontologies for avionics have also been of interest to the Federal Aviation Administration (FAA) Next Generation Air Transportation System (NextGen) and the Single European Sky ATM Research (SESAR) project, but they have yet to be received by practitioners and industry. This paper presents a decision-making computer tool to support ATM personnel and aviators in deciding on airspace situations. It details the AAO and the analytical AI foundations that support such an ontology. An application example and experimental test results from a UAV AAO (U-AAO) framework prototype are also presented. The AAO-based DSS can provide ASA from outdoor park-testing trials based on downscaled application scenarios that replicate takeoffs where drones play the role of different aircraft, i.e., where a drone represents an airplane that takes off and other drones represent AUVs flying around during the airplane’s takeoff. The resulting ASA is the output of an AI cognitive process, the inputs of which are the aircraft localization based on Automatic Dependent Surveillance–Broadcast (ADS-B) and the classification of airplanes and UAVs (both represented by drones), the proximity between aircraft, and the knowledge of potential hazards from airspace situations involving the aircraft. The ASA outcomes are shown to augment the human ability to make decisions.

Mental health challenges faced by foreign nurses: a scoping review

Purpose Foreign nurses encounter various challenges that impact their mental health, but there is a lack of comprehensive evidence on these difficulties and the strategies to address them. This study aims to synthesize the available evidence to identify these challenges and the strategies to support foreign nurses. Design/methodology/approach A scoping review framework was used with an exploration of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, Web of Science, PubMed and ProQuest Central) to search for primary studies. Quantitative, qualitative and mixed-methods research were considered for inclusion, with manual searches of reference lists for potential additions. Studies published between 2013 and September 2023, and written in English were considered for inclusion. Findings About 22 of 1,077 identified studies were finally included in this review. Three distinct themes were identified as contributors to the nurses’ mental health challenges, and one theme emerged to highlight strategies to overcome the challenges. These contributors included the influences of diverse cultures, dynamics within the work environment, language barriers, separation from family and friends, heavy workloads and pressures, disparities in health-care systems and experiences of discrimination. Strategies identified to overcome the challenges were at individual, organizational and policy levels to support foreign nurses in navigating and mitigating stressors. Originality/value This study highlights the importance of targeted interventions to assist foreign nurses in overcoming challenges that may affect their mental health and well-being. Moreover, strategic interventions are crucial to support them in addressing the barriers they faced.

A qualitative study to inform the development of a decision support tool for the diagnosis of pulmonary tuberculosis in Tigray, Ethiopia.

Tuberculosis (TB) is Ethiopia's leading infectious killer disease. The war in the Tigray region of Ethiopia has resulted in the disruption of TB care services. Prediction models are recommended to aid the diagnosis of TB in resource-limited settings. However, the development of such decision-support tools without the participation of end users may not be successful. To inform the tool development, we described barriers to diagnosing TB and identified applicable and desirable parameters for the proposed tool. We conducted a qualitative study between February and June 2023 in two cities in Tigray, Northern Ethiopia. We conducted 12 in-depth interviews and four focus group discussions with healthcare workers (HCWs). Interviews were translated, coded, and analyzed to identify predefined and emergent themes during the thematic analysis. Healthcare workers used symptoms, risk factors, signs, and investigations to diagnose TB. However, failure to ask about antibiotic use, the absence and non-affordability of investigations, and patient load were barriers affecting the diagnosis of TB. Most of the classic TB symptoms and their duration were sorted as very important, simple, reliable, generalizable, and desirable indices. In addition, a trial of antibiotics, being chronically sick-looking, having HIV, having a contact history with a TB patient, and an erythrocyte sedimentation rate fulfilled the above criteria. In the TB diagnostic process, HCWs account for a variety of data, but they prefer the classic symptoms of TB to heighten their clinical suspicion. Antibiotic trials and some risk factors were also considered reasonable. However, when HCWs have a heavy workload and a shortage of investigations, they experience a suboptimal TB diagnostic process. Hence, appropriate context consideration and care providers' preferences for parameters will inform tool development.

Auditor distraction: The case of outside job opportunities for external auditors and audit quality

AbstractPublic accountants are in high demand by non‐accounting firms. While this demand attracts high‐quality accountants to public accounting, it can negatively impact audit quality by distracting auditors. We find that the number of metropolitan statistical area–level busy season job postings for public accountants by non‐accounting firms is positively associated with misstatements. Results are most pronounced (1) when outside job opportunities are from non–publicly traded companies, which likely provide better work‐life balance, and (2) when auditors are under a heavier workload, as captured by higher audit fee‐to‐auditor ratios and increased job postings by audit offices leading into the busy season. Results also suggest that accounting firms that provide large pay increases before the busy season can mitigate the negative audit‐quality effects of busy season job postings for public accountants. These results suggest that accounting firms are not immune to negative effects of auditor distraction from outside job opportunities despite accounting firms knowing that their auditors are highly sought after by non‐accounting firms.

Adaptive memory reservation strategy for heavy workloads in the Spark environment

The rise of the Internet of Things (IoT) and Industry 2.0 has spurred a growing need for extensive data computing, and Spark emerged as a promising Big Data platform, attributed to its distributed in-memory computing capabilities. However, practical heavy workloads often lead to memory bottleneck issues in the Spark platform. This results in resilient distributed datasets (RDD) eviction and, in extreme cases, violent memory contentions, causing a significant degradation in Spark computational efficiency. To tackle this issue, we propose an adaptive memory reservation (AMR) strategy in this article, specifically designed for heavy workloads in the Spark environment. Specifically, we model optimal task parallelism by minimizing the disparity between the number of tasks completed without blocking and the number completed in regular rounds. Optimal memory for task parallelism is determined to establish an efficient execution memory space for computational parallelism. Subsequently, through adaptive execution memory reservation and dynamic adjustments, such as compression or expansion based on task progress, the strategy ensures dynamic task parallelism in the Spark parallel computing process. Considering the cost of RDD cache location and real-time memory space usage, we select suitable storage locations for different RDD types to alleviate execution memory pressure. Finally, we conduct extensive laboratory experiments to validate the effectiveness of AMR. Results indicate that, compared to existing memory management solutions, AMR reduces the execution time by approximately 46.8%.

Perinatal Care Provider Perspectives on Integrating Clinical Research Into the Clinical Infrastructure.

This study explored perinatal health care providers' perspectives on the recruitment of pregnant participants and integrating clinical research into their practice, with a particular emphasis on the complexities introduced by the COVID-19 pandemic. From May to September 2021, semistructured interviews were conducted with 10 perinatal health care providers from an urban US health center. The interview transcripts were analyzed using Braun and Clarke's thematic analysis framework, a rigorous method for analyzing qualitative data by identifying, coding, and reporting themes. This approach allowed us to systematically code the data and identify key themes related to recruitment strategies and integration of clinical trials during prenatal care. Barriers to integrating clinical trials into the perinatal infrastructure included pandemic-related restrictions, heavy workloads, time constraints, ineffective communication and coordination, and maintaining the relevance of the research among providers. Facilitators included the use of communication tools, collaboration with multidisciplinary teams and stakeholders, creation of detailed study information for clinic staff, and fostering commitment to supporting research among providers. The perspectives of perinatal health care providers uncover barriers and facilitators regarding the recruitment of pregnant individuals for clinical trials and shed light on the unprecedented challenges of research in this population during the COVID-19 pandemic and lessons learned postpandemic. This information can support the development of evidence-based solutions and strategies to improve the recruitment of pregnant individuals, as well as enhance clinical research integration into infrastructure in perinatal health clinics.

It doesn't need to be so stressful!

The rapid development of the online delivery in higher education has resulted in a proliferation of research. Key in this work are two critical streams: how to support diverse students in online learning spaces, and the need for greater theorisation to guide educators on the optimal design of such pedagogies. In this study we bring these two streams together by harnessing the lens of self-determination theory (SDT) to explore the experiences of medical students with Attention Deficit Hyperactivity Disorder (ADHD) in their online learning experiences. In doing so, we contribute key theoretical and practical knowledge on supporting innovative, inclusive online learning spaces for our increasingly diverse student cohorts. ADHD is a neurodevelopmental disorder characterised by persistent patterns of inattention, hyperactivity, and impulsivity (American Psychiatric Association, 2022). Studies indicate that the prevalence of ADHD in higher education settings is significant, and medical students are not exempt from this trend with self-reported prevalence suggests it could be as high as 24% (Emmers et al., 2017; Njuwa et al., 2020; Sedgwick-Müller et al., 2022). The nature of medical education, characterised by heavy workloads, time pressures, and complex material, can further pose unique challenges for individuals with ADHD affecting academic performance, professionalism and overall well-being (Im & Tamarelli, 2023). The literature implies that motivational alterations, particularly focusing on internal motivations, exist in people with ADHD, acting as mediators between environmental and social contexts and outcomes including behaviour and performance. Thus, what is the key in this issue is how students are supported to develop and enact their SDT to foster optimal engagement and ultimately their well-being and inclusion (Morsink et al., 2022). In this presentation we will present our findings of semi-structured interviews with medical students diagnosed with ADHD (n=10). Specifically, our study will organise results in relation to the three dimensions of SDT including: student autonomy, competence and relatedness. Findings include the students’ perceptions of the challenges related to flexible delivery, and how greater choice also at times led to barriers around their study decision-making (e.g., to attend lectures, to study asynchronously). Through our presentation we will further provide recommendations on strategies to create inclusive, autonomy-supportive online learning spaces for ADHD students in higher education settings.

The Effect of Hypnobirthing Method to Prevent Imminent Prematural Delivery Through Reducing Stress Levels in Factory Working Mothers

Every day, a total of 800 women die from complications that occur during pregnancy and childbirth. Preterm birth is a major challenge in perinatal health care. In the United States, one in eight babies (12%) is born prematurely; of these, 80% are born at 32-36 weeks of gestation and 20% are born at 22-32 weeks. Premature babies (<32 weeks) are at increased risk of neonatal mortality and morbidity. One of the factors causing premature birth is antenatal depression. A systematic review of studies conducted in developed and low-income countries reported the prevalence of antenatal depression in the range of 5% to 30% and 15.6% to 31.1%). Increased risk of premature birth 1.2 times premature birth and 1.3 times risk of low birth weight. Sociodemographic factors play a major role in the incidence of imminent premature labor. The results of a study in 2014 showed that 54.8% of mothers giving birth at Sidoarjo Regional Hospital had a heavy workload. The results of the study showed that there was a relationship between the workload of pregnant women and the incidence of preterm labor with a p value = 0.008 (P <0.05). Pregnant women with heavy workloads are caused by mothers having jobs with a shift work system, long working hours >7 hours/day or >49 hours/week, working in factories with an average break time of 1 hour and activities such as lifting or pushing goods. In addition, after working outside the home, mothers still do household chores such as cooking, sweeping, washing without the help of others. The reason mothers work on average is to help the family economy. Other factors are anxiety in pregnancy, health risks, domestic violence, length of work per day, nutritional factors during work, length of rest at work, partner support, household income, mother's education level, mother's age, parity Hypnobirthing relaxation provides positive suggestions to the mother. This suggestion changes beta brain waves (conscious mind) into alpha waves (unconscious mind) in the cerebral cortex, then a sensory association process occurs which causes stimuli to be analyzed, understood and arranged into an object and the meaning of the stimulus. The provision of one hypnosis session referring to The Creative Psychosocial Genomic Healing Experience protocol can significantly increase immediate-early gene expression (Zif-268), increase stem cell activity, reduce stress and inflammation at the cellular level. This study aims to explain the effectiveness of the influence of hypnobirthing on reducing the scale of depression in Partus Prematurus Imminens. The expected benefits in this study are to develop the potential for preventing premature labor with the hypnobirthing method.

A cross-sectional study of anesthesia medical staff's occupational and health status in nongovernment medical institutions in China.

Nongovernment medical institutions have gradually become a significant part of China's healthcare system, with a growing numbers of staff. However, the current status of anesthesiology staff in these institutions is unclear. To gain insight into this situation and to compare it with public hospitals, the national anesthesia professional committee of the Chinese Nongovernment Medical Institutions Association (CNMIA) designed and conducted the national cross-sectional survey. We conducted a national cross-sectional study to investigate the occupational and health status of anesthesiology staff in Nongovernment medical institutions. Additional questions were included for the directors of the anesthesiology department to understand their work stress and the reasons for employee turnover. The electronic questionnaire was created using Questionnaire Star and distributed by Anesthesia Professional Committee of the CNMIA through the QR code links and WeChat. A total of 1111 questionnaires were collected, including 989 from anesthesiologists and 122 from nurse anesthetists. The overall job satisfaction score (MSQ) was 75.57 ± 12.32 and the average fatigue score (MFI-20) was 49.10 ± 10.90. High-risk factors for severe fatigue included being aged 31-40, holding a middle title, frequently working night shifts, having long working hours, and participating surgeries classified as ASA III or higher. The most common disease reported was difficulty falling asleep/insomnia. Multivariate logistic regression analysis showed that men (OR = 0.662, 95% CI: 0.482-0.909, p < 0.05), those with a bachelor's degree (OR = 2.152, 95% CI: 1.186-3.903, p < 0.05), individuals with heavy workloads (OR = 2.999, 95% CI: 1.493-6.024, p < 0.01), poor health (OR = 4.280, 95% CI: 1.216-15.057, p < 0.05), and high MFI-20 scores (OR = 1.085, 95% CI: 1.067-1.103, p < 0.001) were more likely to suffer from insomnia. Directors identified medical quality and safety management as their main source of stress and low income as the primary reason for employee resignation. Nongovernment medical institutions have fewer employees, similar workloads, relatively low job stress and higher job satisfaction compared to public hospitals. Low income and difficulty falling asleep/insomnia are significant issues that require attention.

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation.

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria. The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness. The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

Building inclusive Learning Development spaces ‘…but we don’t have time for universal design’

This project sets out to convert a Continuous Professional Development (CPD) workshop on Dyslexia awareness into a series of mini asynchronous learning experiences. The aim is that learning and teaching staff will access the short asynchronous activities by scanning a Quick Response (QR) code; these activities will provide a brief insight into relevant examples of neurodiverse experiences, followed by tips on changes to professional practice that can embed inclusive and universal design. Universal Design for Learning (UDL) is an ethos that we all strive for in our various roles in learning development; It embraces the principles of the social model of disability, which the Office of Students (2019) states ‘is not about “fixing” the individual but about restructuring environments and attitudes around them’. As highlighted by Dettmer and Welton (2024, p.62) the learning community seeks to promote the social model of disability when promoting inclusive learning environments. Stripe and Ntonia’s article on implementing change for inclusive teaching (2023) highlights that the challenges faced include lack of time for staff CPD, negative attitudes towards reasonable adjustments, and mindsets that are not conducive to inclusivity. These factors are sector wide; time is precious for many learning and teaching staff, and attending CPD workshops, particularly when it means adding to an existing heavy workload, are not typically at the top of priority lists. However, as proposed, engaging in a 30-60 second asynchronous activity, might lead to some ‘quick wins’ for the adoption of universal design principles. The proposed short asynchronous activities discussed here are based on experiences of neurodiverse learners when faced with non-inclusive environments, and provide strategies that can be immediately implemented. It is hoped that by scanning a QR code and engaging in learning experiences ‘on the go’, this approach will encourage staff to see that inclusive and universal design can start with small changes and have a fundamental impact on students’ learning experiences.

Assessment of the implementation of early detection of children’s growth and development by midwives

In Indonesia, the SDIDTK (Stimulation of Early Detection and Intervention of Growth and Development) program aims to monitor children's growth and development. SDIDTK monitors growth, encompassing body weight, height, and head circumference. It also monitors development, which includes a development test using KPSP (Developmental Pre-Screening Questionnaire), sight test, hearing test, and emotional-mental development test. This study analysed midwives' application of early growth detection services in Magetan Regency, Indonesia. It used a mixed-method approach. This quantitative study assessed the application of early detection by surveying 53 randomly selected village midwives. The qualitative study was conducted by interviewing 8 participants. The results showed that about 43.9% of midwives falsely reported providing SDIDTK services even when they only monitored the growth aspect without monitoring children’s development. Midwives are helped by cadres who undergo routine growth examinations. Unfortunately, development detection is not routine. The challenges in implementing developmental detection included heavy workloads, limited time, and limited human resources. Other influential factors include the lack of intersectoral cooperation and the fact that societal empowerment have not optimally been established. The SDIDTK program's implementation remains suboptimal. The authors concluded that midwives should improve cross-sector collaboration, empower communities, and set standards for community midwifery care.

Impact of Workplace Bullying on Psychological Distress: Role of Perceived Organisational Support and Religious Coping

Despite the fact that perceived organisational support (POS) and religious coping have been advocated as a crucial component of the stress model, the roles remain unclear among academics that often associate with heavy workloads. Therefore, this study aims to examine the moderating role of POS, and the mediating role of religious coping between the relationship of workplace bullying and psychological distress among academics in higher educational institutions (HEIs). Data were collected from academic staff from private and public universities in Malaysia, and a total of 219 data were used. The results revealed that workplace bullying has a positive impact on academics’ psychological distress, and the POS significantly moderated the relationship between workplace bullying and psychological distress. However, this study failed to support the mediating role of religious coping. This study adds to our knowledge of the stress model, by focusing more on perceived organisational support in minimising psychological distress and less on personal resources (religious coping).

The lifestyle factors of medical doctors in academic hospitals, Bloemfontein, Free State.

Lifestyle factors of medical doctors are essential to their health and well-being. Previous studies omitted factors that constituted a healthy lifestyle and did not differentiate between various medical specialties or level of seniority which may expose doctors to different stress levels, workload and responsibility. The study assessed the lifestyle factors of medical doctors and compared them between departments, levels of seniority, years of experience and gender according to globally recognised health standards. This descriptive cross-sectional study collected data using a questionnaire created by the researchers based on healthy lifestyle factors and was administered online. Access was given to all doctors from four large departments, employed at two academic hospitals in Bloemfontein, Free State who agreed to participate in the study. Consultants from paediatrics, with 6+ years in medical practice, had the healthiest lifestyles. Registrars and interns from surgical disciplines such as obstetrics and gynaecology and surgery, with 1-5 years of medical practice, showed unhealthy lifestyles with inadequate sleep and exercise. The challenge remains how medical doctors can live a healthy lifestyle while managing a demanding schedule. This may impact on the management of their patients and the doctors' overall health and well-being. We recommend improving the working conditions by providing healthy meals on-site at hospitals with adequate breaks, reducing the heavy workload and providing exercise facilities.Contribution:The findings from this article may help improve the lifestyles of the identified groups of at-risk doctors and assist them in seeking ways to improve upon this.

Stress and Overwork in Remote and Isolated Communities: Causes, Impacts, and Solutions

This paper explores the causes and impacts of stress and overwork in remote, isolated communities, where limited services, social isolation, and heavy workloads contribute to burnout and mental health issues. Potential solutions, including better healthcare access, social support, and work-life balance, are proposed to improve well-being in these regions.

Occupational Stress, Psychological Distress, and Coping Strategies of First-Level Judges in the Philippines: Examining the Influence of Demographics and Caseloads

Judges worldwide face intense pressure from heavy workloads, emotionally charged cases, and limited resources, leading to burnout and decreased public trust in the justice system. While individual coping is important, systemic change is crucial. This descriptive-correlational study investigated occupational stress, psychological distress, and coping strategies among 357 first-level judges in the Philippines. The study employed three standardized instruments: the Occupational Stress Scale, the Kessler Psychological Distress Scale (K10), and the Filipino Coping Strategies Scale (FCSS). This study revealed that first-level judges in the Philippines experience high levels of occupational stress and psychological distress. However, they also utilize a range of coping strategies to manage these challenges. The study found no significant relationship between occupational stress, psychological distress, and coping strategies and the demographic profile of the first-level judges. This suggests that these challenges are inherent to the judicial role itself rather than influenced by individual differences. The study concludes that interventions and support systems tailored to the specific demands of the profession are needed to address these challenges. The findings served as the basis for the Wellness Program for the first-level court judges in the Philippines.

Analysis on the Impact of English Teachers' Continuing Professional Development (CPD) on Teaching Ability: A Case Study of Applied Undergraduate Colleges in Henan Province

Background and purpose: With the rapid development of higher education in China and the rise of applied undergraduate colleges, the continuing professional development (CPD) of English teachers is becoming increasingly important. This study aims to explore in depth the impact of CPD on the teaching ability of English teachers in applied undergraduate colleges in Henan Province, analyse teachers' attitudes towards and participation in CPD and its effectiveness, and examine the role of demographic characteristics and teacher creativity in this process. Method: A mixed research method was used, combining quantitative and qualitative analysis. A questionnaire survey was conducted among 294 English teachers (with a 85.5% response rate) from 10 applied undergraduate colleges in Henan Province. The questionnaire included aspects such as teachers' background information, frequency of CPD participation, attitudes towards CPD, and perceived teaching ability. In addition, 20 semi-structured interviews and four focus group discussions (24 participants in total) were conducted to obtain more in-depth qualitative data. Descriptive statistics, correlation analysis and multiple regression analysis were performed using SPSS software, and Hayes' PROCESS macro was used to analyse moderated effects. Main results: Teachers had a generally positive attitude towards CPD (mean score 4.587/5), but institutional support was lower (mean score 3.326/5). There were significant differences in the frequency of participation in CPD activities: professional reading had the highest participation rate (65.9% participated frequently or very frequently), while industry-university cooperation had the lowest (only 22.8%). CPD had a positive impact on all aspects of teaching ability, especially technology integration (72.5% reported a significant or transformative impact). Multiple regression analysis showed that the frequency of CPD participation was the strongest predictor of perceived teaching ability (β = 0.458, p &lt; 0.001), followed by attitude towards CPD (β = 0.265, p &lt; 0.001). Teacher creativity significantly moderated the relationship between CPD participation and teaching competence (B = 0.087, p = 0.026), indicating that teachers with higher creativity are better able to translate their CPD experiences into teaching practice. Heavy workload (65.6%) and insufficient time (59.5%) were the main barriers to CPD participation. Technical training (64.9%) and reflective practice groups (59.2%) were the most popular types of CPD activities. Conclusions and recommendations: The findings of this study highlight the important role of CPD in improving the teaching capacity of English teachers in applied undergraduate institutions, while also revealing the challenges in the current implementation of CPD. Recommendations for educational institutions are as follows: Increase institutional support for CPD to create more time and resources for teachers to participate in CPD. Design a diversified CPD programme with a balanced mix of activities, with a particular focus on industry-university collaboration and action research. Focus on technical training and reflective practice to improve teachers' digital literacy and innovation capabilities. Develop personalised CPD pathways that take into account teachers' career stages, educational backgrounds and career aspirations. Explore more flexible CPD formats, such as microlearning modules or blended learning approaches, to overcome time and workload barriers. This study provides an empirical basis and practical guidance for the CPD of English teachers in applied undergraduate colleges in Henan Province and even in China, which is of great significance for improving teaching quality and student learning outcomes.

Provider Perspectives on Healthcare System Barriers to Engaging Caregivers of Rural US Veterans in Firearm Suicide Prevention.

Firearms account for the majority of US Veteran suicides. Studies demonstrate that secure firearm storage can decrease risk of suicide. Veterans prefer to have discussions about secure firearm storage with familiar individuals, such as their caregivers. Providers in the Department of Veterans Affairs (VA) are well-positioned to engage caregivers of Veterans in firearm suicide prevention; however, challenges remain. Elucidate healthcare system barriers to caregiver engagement in firearm suicide prevention, as seen by Suicide Prevention and Caregiver Support Program staff, to inform development of an intervention to increase involvement of caregivers in efforts to reduce Veteran firearm suicides. An Advisory Board consisting of key stakeholders provided input regarding study methods and interpretation of findings. Participants included 16 Caregiver Support Program and 14 Suicide Prevention staff recruited from 8 geographically diverse rural VA medical centers. Interview topics and data analyses were guided by the Consolidated Framework for Implementation Research (CFIR). Rapid analysis and a team-based approach were employed to identify key barriers; emergent themes were mapped onto relevant constructs of the CFIR inner setting domain. Healthcare system barriers included structural characteristics (e.g., understaffing and heavy workloads), relational connections and communications (e.g., poor channels of communication between Caregiver Support Program and Suicide Prevention staff), culture (e.g., lack of recipient-centered care), and access to knowledge and information (e.g., lack of training in how to incorporate caregivers in Veteran care). The present study provides much needed perspective from VA staff in Suicide Prevention and Caregiver Support programs regarding barriers to involving caregivers in firearm suicide prevention efforts within the VA healthcare setting. Identifying these barriers and potential solutions is a critical step towards increasing engagement of caregivers in reducing firearm suicide among Veterans.

Enhancing cross-border contact tracing in Europe: Lessons learned from COVID-19 and future directions

Abstract Introduction Health systems in the EU operate at the national level, granting Member States autonomy for outbreak preparedness and response within their territories whilst coordinating at EU level to combat serious cross-border threats. The EU’s Early Warning and Response System (EWRS) provides the platform to exchange personal data for contact tracing across 30/EEA countries and was extensively utilized during COVID-19. This study examines insights from EU/EEA countries and assesses the feasibility of integrating national digital systems with EWRS to increase its effectiveness. Methods A comparative case study surveyed representatives from 24 countries and interviewed nine, analyzing contact tracing processes, actors, digital technologies, and challenges/facilitators during COVID-19. Thematic analysis was complemented by two webinars engaging EU/EEA countries to validate findings and gather additional perspectives. Results EWRS was valued for safety and efficiency but faced challenges during peak pandemic periods due to the heavy manual workload. Integrating national digital systems with EWRS could enhance data quality, timeliness, and coordination between countries. However, countries have varied and incompatible digital contact tracing systems, limiting the feasibility of their integration with EWRS. Moreover, most countries organize contact tracing at the subnational level, with regional entities developing and managing their own digital technologies under national guidance. Smaller countries excluded, subnational contact tracing case management systems were often not integrated with each other to exchange personal data in an automated way at a national level. Conclusions While integrating national digital systems with EWRS could bolster efficiency of contact tracing across EU/EEA, the presence of diverse technologies and decentralized governance poses feasibility challenges. Other improvements are needed to enhance cross-border contact tracing during outbreaks. Key messages • Integrating national digital systems with EWRS promises enhanced efficiency for contact tracing across EU/EEA in line with Regulation (EU) 2022/2371 on serious cross-border threats to health. • Diverse technologies and decentralized governance pose feasibility challenges, underscoring the need for further enhancements in cross-border contact tracing in EU/EEA during large outbreaks.